Endocervical Microbial Pattern, Antibiotic Sensitivity and Complications Seen With Septic Abortion at Kenyatta National Hospital in 2018.

Abstract

Background:Globally an estimated 56 million induced abortion occur every year(1). WHO estimates that 68,000 women die annually due to complications of unsafe abortion with sepsis as the primary cause of death(2). Microbial culture and sensitivity testing in a low resource setting, is not only expensive but takes an average of 3days to get the results. Many patients present with septic complicationsarising from the abortion when it’s too late to put them on appropriateantibiotics based on the culture and sensitivity results. Objective: To determine the bacteriology,antibiotic sensitivityand complications among patients presenting withseptic abortion at KNH. Methodology: Descriptive cross sectional study, comprised a total of 81 women, with evidence of abortion related sepsis. Samples of endocervical swabs from women with signs and symptoms of septic abortion were collected at recruitment and taken for m/c/s. The participants were followed up till discharge for complications. Statistical analysis was done using SPSS 21. Proportions were compared using Chi2 test, 95% CI with p-value significant at p<0.05. Results:The commonest bacteria isolated on culture were, Escherichia coli (25%), Klebsiella Pneumonia (20%) and Staphylococcus aureus (15%). A high resistance was noted with amoxicillin-clavulanic acid, cephalosporin and cotrimoxazole. In 90% of the cases, organisms were sensitive to Gentamicin, amikacin and meropenem. 8 participants had complications, among them peritonitis, pelvic abscess, septic shock and renal failure. Laparotomy was done in one case. There were two mortalities in our study giving a case fatality rate of 2.47%.

Conclusion: New guidelines for the management of septic abortion should be considered in this population due to the high resistance pattern to the commonly used antibiotics.Septic abortion has serious health complication and needs to be urgently addressed to reduce maternal morbidity and mortality.